Gynecomastia

The symptoms of gynaecomastia or male breasts are:

• Enlarged breasts which can either be firm or rubbery
• Stretched areola (the dark area around the nipple becomes stretched)
• Pain and tenderness in the breasts
• Swelling starts from below the nipples and extends outwards over the breast area

If gynecomastia or man boobs is due to a genetic condition, the patient may exhibit other symptoms like poor sexual functions, small sex organs (small penis and testicles), less facial and body hair, low sex drive and infertility.

There are various reasons that can lead to gynecomastia in a person:

• Genetic: Genetic conditions like Klinefelter syndrome - in which males are born with one extra X chromosome (usually males are born with one X and one Y chromosome). The boy affected by this syndrome would present with symptoms like gynaecomastia, small penis and testicles, low muscle tone and infertility in adulthood.
• Hormonal imbalance: If the levels of estrogen increase in the body of a male, he can develop female characteristics like breast enlargement.
• Obesity: The levels of estrogen can increase in a person with obesity. This can lead to gynaecomastia.
• Puberty: During puberty, the levels of the hormone may vary which can lead to gynaecomastia in boys. It clears up after the hormone levels get back to normal.
• Medications: There are some anti-androgen medications like 5 alpha-reductase inhibitors, spironolactone and cimetidine, bicalutamide and flutamide which can cause breast enlargement in males. 
• Liver cirrhosis: In the case of liver cirrhosis, the normal liver tissues get replaced by scar tissues. Some studies have concluded that gynaecomastia is seen in most male liver cirrhosis patients. 
• Chronic renal failure: Researchers have found evidence that transient gynaecomastia is one of the common features in male patients of chronic kidney disease. Other symptoms seen in those patients are tenderness of the breasts and small testes.
• Tumours: The presence of gynaecomastia can be an indication of testicular tumour in a man. Tumours like Leydig cell tumour, gonadal germ cell tumour and the adrenal tumour can lead to gynaecomastia in a man. 
• Steroids: Use of anabolic steroids (man-made steroids) can lead to gynaecomastia in a person.

If man boobs gynaecomastia is due to an underlying disease, then there is no way of preventing the condition. Some of the things that can help prevent gynecomastia are:

• Do not use steroids without a doctor’s prescription.
• Control your weight by eating healthy and exercising daily. 
• Ask your doctor to change the anti-androgen medications which can lead to man boobs or gynaecomastia.

Man boobs or gynaecomastia is diagnosed by drawing blood samples from the infected person. This blood is tested for serum testosterone and estradiol. The luteinizing hormone (LH) test and beta hCG test may also be done to check for gynaecomastia.

If the tests show low testosterone, low LH and normal estradiol levels, this may indicate secondary hypogonadism (or low testosterone levels linked to a problem with the pituitary gland). (Read more: Male hypogonadism)

A biopsy can be done to find out if the mass growing in the male breasts is benign or malignant. (Read more: Cancer diagnosis)

Tests like liver function test, kidney function test and thyroid function test may be recommended to rule out liver failure, kidney failure, or hyperthyroidism, respectively.

The treatment of gynecomastia or male breasts firstly involves treating the underlying condition:

• Hormonal imbalance is treated with the help of hormone therapy in the form of testosterone medications, patches or gels, which must be prescribed by a medical professional.
• Underlying diseases like thyrotoxicosis, renal or hepatic failure are diagnosed and treated accordingly.
• In the case of drug-induced gynecomastia, the medication is discontinued as soon as the treatment is complete. An improvement is usually seen immediately after discontinuing the drug. The doctor may also change the medication to reduce its effect on the male breasts. 
• Tumours are surgically removed, followed by chemotherapy (in some of the cases) using cisplatin, bleomycin and either vinblastine or etoposide.
• If the biopsy shows malignancy, then complete mastectomy (removal of the breast) is done. 
• In the case of just excess fat deposition in the breast tissue area and no malignant mass, the doctor may perform liposuction to suck out all the excess fat.  

The doctors may try certain medications for treatment if the gynecomastia does not have any underlying treatable cause and has been prevalent for less than six months. There are three classes of medical treatment which are given for man boobs or gynecomastia: 

• Androgens: These medications increase the level of male hormones in the body. These are testosterone, dihydrotestosterone and danazol. 
• Anti-estrogens: These medications reduce the effect of estrogen in the body. These are clomiphene citrate and tamoxifen.
• Aromatase inhibitors: These drugs are specifically used to treat gynecomastia (male breasts) as they stop the production of estrogen in the body. These are letrozole and anastrozole.